Welcome to our introductory article on Diabetes Mellitus. We are lucky to be joined by Diabetes Educator, Ann Morris, for a series of educational and informative articles about living with diabetes. Ann and I formed a successful partnership at St John of God Healthcare around seven years ago. I'm happy to say that Ann is a wholistic pracititioner who works from a biopsychosocial perspective, referring people regularly to mental health practitioners like myself, to assist her patients who maybe experiencing complications such as diabetes burnout, depression and anxiety. I'm proud to collaborate with her in practice, and also on these articles. We hope you find them useful.

Diabetes Mellitus is a chronic condition caused by a complete (as in Type 1 diabetes) or relative lack of insulin (as in Type 2). This causes high blood glucose (sugar) levels and requires management using a combination of healthy eating, regular exercise and weight loss (if required). Not everyone diagnosed with diabetes needs to lose weight but awareness of the importance of a healthy lifestyle and any changes needed, will help to manage this condition and reduce other risk factors such as heart disease while improving long-term health.

In healthy people, glucose is taken up efficiently by body cells. When we eat, carbohydrates from food are broken down into glucose. Once the digestive system releases it into the bloodstream, the glucose is available to all of the body's cells. Glucose is the main source of energy, so when glucose levels drop below normal, our ability to function mentally becomes impaired - you might feel spaced out and lose your ability to concentrate.

Excess glucose is stored in the liver as glycogen and also in the muscles for later use. The pancreas secretes a hormone called insulin whenever a surge of glucose hits the bloodstream. Insulin helps the body's cells to take up the glucose where it's used for immediate energy. Insulin also helps with the conversion of glucose into glycogen for future use. These actions lower blood glucose levels.

Classification or Types of diabetes includes the following:

Impaired Glucose Tolerance (otherwise known as Pre-Diabetes):This may occur prior to the diagnosis of diabetes being made but may also be found in people whose blood glucose levels are higher than desired, but who never develop diabetes. Normal blood glucose levels are 3.5 to 7.8 mmol/L so if glucose levels exceed the upper level, impaired glucose tolerance is diagnosed.

Type 1 Diabetes:

T1 is an auto-immune condition caused by the body's immune system destroying the insulin producing cells in the pancreas. These are called Beta cells and this leads to a complete depletion of insulin.

Type 2 Diabetes:

T2 occurs when high blood glucose levels occur due to insulin resistance. This is often triggered by poor health i.e. a heart attack or stroke, steroid use, ongoing major stressors, depression, or poor lifestyle - including obesity, and lack of exercise.

Gestational Diabetes:

This type of diabetes occurs in pregnancy. At 26-28 weeks an Oral Glucose Tolerance Test is done on all women.

As diabetes is a chronic condition, it requires lifelong management. There are several lifestyle behaviours which are modifiable and assist in the management of diabetes. These include:• healthy eating• regular physical activity• and, where required, medication. In Type 1 diabetes, insulin treatment is commenced at diagnosis.

The Diagnosis:

As well as the difficulty of receiving a diagnosis of diabetes mellitus for yourself or a loved one, people may also experience a degree of judgement and stigma around the diagnosis. Talking with a sensitive diabetes educator is going to help manage your feelings and start to provide informed choices for you and those close to you.

Denial, grief, shock and a degree of trauma are common and normal responses to receiving a diagnosis of a chronic condition and it is very important that education and support is made available as soon as possible to reduce the impact of the diagnosis and to assist with coping and managing the disease.

The diagnosis of diabetes can cause many feelings and responses depending on who in your family is diagnosed, the type of diabetes and past experiences with people you have known who developed diabetes. Often, Type 1 diabetes is diagnosed in young children and so their parents often experience the trauma and emotional responses as much, if not more than the child who still may not have a comprehension of the impact it could have on their lives.

Feelings following diagnosis may include but are not restricted to denial, grieving over the loss of your health or changes to your lifestyle, anger, frustration, a sense of failure, anxiety and fear. For anyone living with a chronic condition, risk of the development of depression and anxiety increases due to the chronicity of the illness.

Many people in the community believe that Type 2 diabetes is totally avoidable but in fact, while this type of diabetes is closely associated with lifestyle choices, a family history of diabetes is a contributing factor and increases your chances of developing diabetes.

Prompt referral to Diabetes Education services is essential in a timely manner to ensure active management is facilitated. Your doctor and diabetes educator will ensure that all of your physical and emotional needs are met by referring to appropriate external services including mental health services, if required.

Ann trained at the Royal Melbourne Hospital and following her training worked at the Royal Children's Hospital in 1976 where her connection with Type 1 diabetes began. She has been in Diabetes Education since this time. Ann is a founding member of the Australian Diabetes Educators Association and an honorary life member. Ann was awarded the JDRF "Diabetes Educator of the Year for Impact and Relationships " in 2011, Diabetes Educator of the year, Victoria 2016 and Australian Diabetes Educator of the Year 2016. Ann is a Credentialed Diabetes who works in her own practice in Warrnambool and who describes herself as a psychologically sensitive practitioner, which she certainly is. You can contact Ann through her Facebook page AMCON Diabetes Management Services.

Worldwide, obesity has doubled since 1980. In 2014 the World Health Organisation (WHO) reported that 1.9 billion adults were overweight with 600 million of those being obese. Obesity kills more people per year than being underweight and it is preventable. Bariatric surgery - weight loss surgery - are surgical methods to help people achieve weight loss. This year, Texan writer Rocky Hatley underwent surgery to achieve weight loss. As at the time of posting, Rocky has lost 42.18kg (93 pounds)!He's written a three part Up Close & Personal account of his journey for us. You can find Part I here and Part II here. This is the third and final part. Thank you Rocky for sharing this unique personal insight into your experiences.

I marched right up to the front desk and stated my name. The lady told me to wait in the area just behind her.

I didn't wait long.

"Mr. Hatley?"

I stood and followed the nurse into the prep area where a couple of patients had already donned their gown and socks.

I donned mine and struggled into the bed.

The nurse glanced at her chart. "Dr. Hafford will be with you shortly."

Apprehension covered me like a horse blanket, scratchy and hot. I didn't want it. Not at all. The gallbladder surgery had been an emergency situation. This had been elective on the one hand, but necessary enough for the insurance company to pay for it on the other.

Dr. Hafford walked in wearing blue scrubs and her patented smile.

Every molecule of fear and apprehension melted away like morning frost. In fact, I looked forward to my recovery. She reiterated what would happen in the operating room, and would go ahead and run the various tests for leaks while I was under the anesthetic.

The anesthesiologist came in. Dr. Hafford left to prepare the operating room.

The orderlies rolled the bed down a short hallway and into the operating room. It had fewer spotlights, machines, and other accouterments than operating rooms in movies and television did. Naturally.

I helped the staff scoot me off the bed and onto the operating table.

"See you in a little while," Dr. Hafford said.

I turned my head to the left, and drifted into oblivion.

I woke feeling like I had been kicked in the gut in a bar fight. The recovery nurse greeted me and told me that everything went well.

"Dr. Hafford performed the leak test. It's perfect. We'll get you to your room in just a little bit. You won't feel like it, but we want you to walk as much as possible."

"As long as I'm not lapped by a 97 year-old lady, I'm fine."

Bless her heart, she looked at me as though the light had fallen out of my bulb, but this actually happened to me during my recovery from the gallbladder removal surgery.

Maybe she was right, though.

I had just emerged on the far side of bariatric surgery. The sleeve gastrectomy. Three quarters of my stomach gone to join my gallbladder in that great formaldehyde jar in the sky. Kicked in the gut or not, I determined to make it work.

But first I had to pee. I didn't feel like I had to pee, but the nurse said she wasn't going to leave me alone until I filled the measuring cup on my nightstand. Being a lifelong member of the Shy Bladder Club, I explained that I wouldn't be able to do the job until she left me alone.

An enlarged prostate didn't help.

Stalemate.

She thought a second. "I'll give you three minutes."

As she left, I took a good-natured parting shot. "It might even take five minutes if I think you're hovering outside the door."

She gave me the five minutes.

I gave her nothing. Not a single drop.

"I can explain this," I said when she stared at the empty container. "I've had less than half-a-pint of water all day long."

I had her. I knew it.

She pointed to the IV. "You've had a lot more than that, sport. This is your third bag."

Oops. Forgot about that, didn't I?

"I just don't have to go," I said with a smile and shoulder shrug.

She considered a moment. "I wonder. You're still numb down there. Lie down and we'll find out."

I struggled back into the bed while she left the room. How would she find out?

About four minutes later, she came back rolling a cart loaded with equipment.

Hmmm.

She drew it over to the left side of the bed leaving the door open, yanked my hospital gown up to my chest exposing me to the world, and put this sonogram-like probe just below my belly button.

"You're full," she said.

How could she tell that? Oh, well. I'd just have to try a little harder. I'd ask for ten minutes.

No problem.

I didn't get the chance.

"Just relax, Mr. Hatley," she said and took what was left of my manhood into her hand.

Then I saw the tube.

Oh, no. Oh, no. No.

"I can go. I promise."

She ignored me, matched the tube to my alter ego, and was off to the races.

"Oh, no! No! You're going up the down staircase! Please!"

"Just relax, Mr. Hatley," she said.

"Oh, sh*t! HOLY F***ING SH*T!"

That she had shoved that damn catheter tube north on my southbound road bothered me far more than the pain. And it did hurt. Make no mistake. It HOIT!

"Look at that," she said, obviously satisfied with herself. "You filled the bag."

She retracted the heinous tube. I recovered from the shock of what she had done, happy for the first time in my life that nature had not seen fit to provide me with what teenage boys dream about.

"Mr. Hatley," she said, storing her equipment. So help me, I would have screamed to high heaven if she treated me like a little boy who made just made bubbles in the toilet. "We got 750 milliliters right on the money."

She sounded happy. I eased myself down into the sheets, relieved.

"Damn, that would have filled an empty wine bottle," I replied, thinking that if it hadn't been for drugs and alcohol, we Americans wouldn't know anything about the metric system.

The nurse smiled, said "Goodnight, Mr. Hatley," and wheeled the equipment out of the room.

The next nurse who came in a little later seemed surprised to see me. "Did something happen, Mr. Hatley?"

I wondered whether to mention the catheterization, then decided that she would see it on the chart. I had no intention of mentioning it.

Wow. On the one hand I felt about as welcome as a fart in a spacesuit. I had become a "sleever," whoop-di-doo.

On the other ...? Did something go wrong and they weren't telling me about it?

Not possible. Even with the streptococcal sepsis, they told me. They hedged. They coated it in confectioners sugar and put a cherry on top. They painted it with rainbow colors, but they told me.

No. This is the way things were supposed to be.

And at that point, I took my first step toward recovery. I flushed the toilet and a whole bunch of waste spun into oblivion.

Another nurse came in to take care of me through the night. One who didn't call me a "sleever."

She called me "Mr. Hatley." I wished that she called me "Rocky" or, better yet, "Rock," but I do understand protocol.

The next morning, I didn't worry about my weight, or eating, and it barely registered that I had not swallowed a single calorie since the surgery. I worried about sipping the chocolate protein shake they brought explaining that I could go home after I finished it and Dr. Hafford had checked on me.

An eleven-ounce chocolate protein shake.

Looked easy enough. Only a hundred and sixty calories. Hell, I could have handled that in two mighty swigs. I did know that I only had a quarter of my stomach to hold it, but half-an-hour seemed like a reasonable goal.

Until I took the first sip and found myself stuffed. I set the cup down.

"Are you nauseous?" the nurse asked anxiously.

"No. Just full."

I spent the next two hours drinking that eleven-ounce (325 ml) protein shake. Forcing some of it, to be honest. I managed one more shake at home later that afternoon.

Home. I had made it through the surgery.

The next morning I faced one helluva big fear. For each of the next 14 days, I would have to give myself an injection to help prevent Deep Vein Thrombosis (DVT). Dr. Hafford admonished me to either give myself the injections or bring them to the office each day so that a nurse could give them to me.

And, since I occasionally had given my late sister insulin injections and my late mother injections to keep her white blood cell count up during chemotherapy, it only seemed right that I give them to myself.

I cringed every morning giving them. It only hurt a couple of times, but the bruising that resulted made me look like I had actually been kicked in the gut in a bar fight.

I deliberately didn't weigh those first two weeks. I didn't want to know. Since I could not eat anything more than a protein shake and a little sugar free Jell-O, it would take care of itself.

My first weigh in came two weeks after the surgery. 304.23. Twenty-three pounds down. I shrugged. Nothing more than a bucket of water out of the ocean. I'd ridden that bull a few times and been bucked off and trampled. When Dr. Hafford came in, she seemed pleased. Then again, I never saw her when she didn't have a smile and a laugh ready to go.

"The incisions look great," she said lowering my shirt. "The one in the lower right is still sore, isn't it?"

I smiled. "How did you know that?"

"That's where I took your stomach out."

Ohhh. I might have cringed a bit.

"I'm sorry about the bruises," I said.

"Oh, don't worry," she replied with a dismissive wave. "That's how I can tell you've been taking the shots. Remember, they're to prevent clotting, so you're going to bruise. You'd have still bruised if we had given them to you."

Of course. I knew that!

Yeah, right.

We scheduled another appointment two weeks later, at the one-month mark. Again, I stayed off the scales, but added soup, cereal, and oatmeal to my diet taking in about 300-500 calories a day. I ate four or five small bites at a time, and had to remind myself to eat those.

I drank water, hot tea and iced tea, broth and protein shakes.

At the one-month mark, my eyes opened wide on the doctor's scales. 288.5. Less than 300.

That got my attention.

A milestone. Thirty-nine pounds down.

I really noticed the changes after returning to work. No more holding on for dear life going up and down stairs. I could stand longer, walk farther.

I had more energy.

Wow.

I hit the fifty-pound mark a couple of weeks later. My primary care physician fist-pumped. I beamed with pride.

My energy level soared like an Air Force jet into the wild, blue yonder. So did my attitude on life. One morning, I woke looking forward to the coming day, not just accepting it.

As of this writing, I am down eight-six pounds (39.01kg) and still going. My calorie intake has increased to 700-800 calories a day, with a once-a-week spurge to 1,000. Shhh. Don't tell Dr. Hafford about that splurge. But I can't eat more than just a little at each sitting. And that is both amazing and wonderful.

I can enjoy each bite, then stop because I'm full. Eating beyond full goes beyond uncomfortable. It's painful.

One egg and one slice of bacon is a meal that will stuff me. A small cup of soup and five crackers is a full meal. So is one slider. So is one corn on the cob (with butter and salt).

Over these last months, I've come to enjoy the way I eat. Three, maybe four tiny meals a day. Different foods each time. I love it. I experiment like I never have before, especially since a big meal for me now is not much more than a snack for most people.

I make every bite count.

And I'm saving a boatload of cash.

I take a multi-vitamin for men over 50 and a vitamin for my eyes, plus a low dose aspirin, all over-the-counter. The three-month blood tests came back perfect.

My exercise consists of walking, and this very week, I bought a couple of swim suits and will soon get back to lap swimming, my favorite exercise. Soon, I will look at my whole body in the mirror and marvel at my ability to return to the world of the living.

I feel some of that now.

For years I merely existed, slowly stomping through life like a mule with a yoke bowing its head plowing through the back forty. I'm loving life again and can't wait to see what these next years have to offer, and what I can give to these next years.

Despite the warning of the psychologist, I have not regretted having the surgery one microsecond. I've thanked the Powers of the Universe for it. Looking back, I could not have done this on my own.

I've been blessed with the support of family and friends. After my surgery, I received a gift in the mail. A beautiful koala teacup that I use every morning for my first cup of tea. With it came a note.

Dearest Rocky,

You've taken the hardest step now! Well done. The worst is behind you & what lies ahead is a future filled with self-confidence, love of yourself & the total embracement of all that you are.

Lots of love,

xoxo

I keep that note on my desk and glance at it from time to time, amazed by how swiftly the sentiments are swirling into reality.

I have a long way to sail, true. But when the ocean seems infinite, I reflect on a passage from a beautiful novel of survival called "Men Against the Sea" by Charles Nordhoff and James Norman Hall featuring an honorable and heroic Captain William Bligh, yes, the villain of "Mutiny on the Bounty." He tells a seaman during desperate times, "Think if you like of the distance you have come, but never let your mind run forward faster than your vessel."

Advice that I, too, am working on.

So, yes, I need to lose another sixty or seventy pounds, but I've come farther in these few months than I've dared hope for in more than sixteen years. I've started to embrace myself, and accept myself— possibly for the first time in my life—and can see all that I can become if I conscientiously work toward it with a will. I look into the mirror now, and really like the guy looking back. His smile is infectious. His eyes shine with the love of living. And sometimes I see a faint glow surrounding him.

Yes, every once in awhile, I catch myself loving him.

These days I don't dwell on what might have been, because it wasn't. It never will be. I look on what will happen, because I can make it happen.

And I fully intend to.

Things aren't always rosy. This is life, after all. But the highs are so much higher, and the lows don't hurt nearly so much.

Wine is an occasional part of a meal.

I remember my father's saying, "Chief, sometimes it's the bigger man who asks for help, rather than the one who plows on alone."

I gave in and asked for help. And I'm happy and proud that I did, because help has come to me in tsunami-like waves from friends all over the world.

People in my life say it took guts to do what I did, and maybe so. I'm happy about that, too.

I'm happy about so many things these days.

I'm happiest, though, because in this, my sixtieth year, I've become a man.

The End

Rocky Hatley has been a Screen Actors Guild Member for over 25 years. He was born in Memphis, Tennessee more years ago than he would like to think about, and, as a child, was held by Elvis Presley. Raised in Texas, USA, he's a massive fan of music, plays guitar, and has the most amazing celebrity stories ever. Rocky is a passionate writer currently working on a novel loosely based on his experience as a SCUBA diving instructor. He is the co-writer of two plays produced at Manhattan South Theatre in Orlando, Florida. Barstruck and Bedtime Stories each enjoyed successful six-month runs. Rocky appeared in both. In his life he has, at times, been too thin and too heavy. This is an article about Rocky's journey to follow the lead of Goldilocks and find the "just right."

Worldwide, obesity has doubled since 1980. In 2014 the World Health Organisation (WHO) reported that 1.9 billion adults were overweight with 600 million of those being obese. Obesity kills more people per year than being underweight and it is preventable. Bariatric surgery - weight loss surgery - are surgical methods to help people achieve weightloss. This year, Texan writer Rocky Hatley underwent surgery to achieve weightloss. He's written a three part Up Close & Personal account of his journey for us. This is the second part. Read Part I here and Part III here. Thank you Rocky for sharing this unique personal insight into your experiences.

My mind stopped there, not even noticing the "... and Minimally Invasive General Surgery." I honestly believed that my primary care physician had dealt with me long enough on the weight and had recommended me to a bariatric surgeon as a last ditch effort to save my miserable life.

Had I really become one of those fat people too damn weak to get his life back in order? Or maybe it took more than desire to get the job done.

I scheduled that appointment and took that long look in the mirror, right into my sad, droopy eyes. Then down to my overhanging gut, then at my fat-dimpled rear end, then back into my eyes. The time had come for desperate measures. I had tried so very hard for so very long to stay on a healthy eating plan. I would lose twenty pounds, then gain twenty-five back. Would sit down to a nice glass of wine and finish the bottle, then another, and barely be buzzed because I had polished off a medium pizza and an order of Buffalo wings right before.

It would have taken a third bottle to take me over the hill into drunkenness. A fourth to start slurring and staggering.

I loved wine, especially during alone times. It helped me forget my misery. And alone is where I endured misery most. To the world, even to close friends, I flashed a smile and a laugh because I truly believed in the words of the American poet Ella Wheeler Wilcox from 1883 ...

Laugh, and the world laughs with you;Weep, and you weep alone;For the sad old earth must borrow its mirth,But has trouble enough of its own.

Almost before I knew it, I struggled onto the examination table for the consultation. In walked a young woman about thirty-five years old with a huge smile, white lab coat featuring her name "Melanie L. Hafford, MD, FACS," hand extended. I shook it firmly.

"Mr. Hatley, I see you have a balky gallbladder."

I made up my mind to discuss my larger problem as well. "That and balky dieting practices over the decades."

She laughed. "Well, let's see if we can take care of both."

She went over the process of removing my gallbladder, which didn't seem nearly as daunting as I had feared. We then went over the gastric bypass and the sleeve gastrectomy surgeries.

By the end of the consultation, I had complete faith in her. That kind of confidence in a doctor had only happened to me once before, when I met my first physician beyond pediatrics.

I'd been twenty-three. He had been my late father's physician. He remained my doctor for the next twenty-one years, until his retirement.

For the first time in such a long time, I experienced hope.

"Can we do them at the same time?" I asked, essentially committing myself to bariatric surgery.

"We can try," she said, and I heard a hint of doubt in her voice, like a grating of nutmeg over a plate of Brussels sprouts. "Because of insurance requirements, it'll be about six months or so before we can do the bypass or the sleeve, whichever one you choose, and, well, to give you a chance to really think this thing through. I don't know if your gallbladder will wait that long. Let's talk it over in a month when you come in for your first weigh-in and we start the process."

My sludgy gallbladder didn't wait the month.

It's a story for another time, but suffice it to say that another trip to the emergency room, followed by emergency surgery to remove my gallbladder, a nine-day stay in the hospital, and six weeks at home recovering opened my eyes nice and wide.

I needed to do something even if it was wrong. And I understood deep in my core that I would not be able to do it alone. I needed help.

Oh, God, I needed help.

One of my father's sayings rang in my ears like a song, "Chief, sometimes it's the bigger man who asks for help, rather than the one who plows on alone."

The bariatric surgeon.

Dr. Hafford.

I called and made an appointment.

She saw me first because of my gallbladder. Now, no more gallbladder. But I had a stomach that made up for it and, though I had lost twelve pounds in my involuntary nine day fast in the hospital, I made sure to eat enough to fill the empty space, put that weight back on and gained some more.

She walked in, smiling. We shook hands.

"So, your gallbladder didn't wait."

I shook my head. "No. It didn't."

She checked the incisions. "They look great. Who did the surgery?"

"Dr. Clifford."

"He's good. Well, let's move on to the next step, then."

She pulled out some paper and drew images of what would happen with the gastric bypass (which I gathered would divide the stomach into two sections then rearrange the small intestine to connect to both) and the gastric sleeve (which would remove three-quarters of my stomach).

She recommended the sleeve.

I agreed.

"Good. So you'll need to come in once a month for six months for weigh-ins, you'll need to see a psychologist, and take a sleep study test for sleep apnea, get clearance from a cardiologist, and meet with a nutritionist. All of this is so the insurance will cover the surgery."

"I can do that."

"Excellent. We'll make today weigh-in number one and move on from here."

That quick. That simple. That easy.

I had joined the ranks of those in line to have the gastric sleeve. Maybe I would move an inch toward changing my life like all of the commercials claimed. I didn't care about that big of a difference. Truly, I didn't. Wishing for that would be like a wolf baying at the moon, and I would not put myself through that torture. I would never again wish for something I couldn't have.

I just wanted to be able to walk more than ten minutes before needing to sit for fifteen. I wanted to be able to tie my shoes while they were on my feet. I wanted to be able to get out of a chair without having to count to three by halves and then quarters and then eighths. I wanted to go to the State Fair of Texas with my friends and walk around with them to see the exhibits and ride the rides. I didn't care anymore about eating the funnel cakes and the corn on the cob mushy from the butter and the corny dogs covered in mustard.

Well, I did want a corny dog covered in mustard.

I couldn't give it all up.

I spoke to everyone I needed to speak to. A psychologist had me fill out a lengthy questionnaire, saw me for an hour, asked me questions, had me memorize three words which he asked me to repeat several times during the session. We talked about my parents, my siblings. Mostly, I think he wanted to know how I felt about the surgery.

I smiled. "Look, I know it's not a miracle cure. I have to do my part, and that it won't be easy. The surgery isn't the fix. It's an assist. The fix is still on me. I'm just asking for help."

"I do want you to know," he said concluding our visit, "that it's common for people to regret having the surgery after having it. That's something you may have to deal with."

Despite everything, I found it next to impossible modifying my diet and caloric intake, though. I would do well for a week or two, then the chicken fried steak swimming in cream gravy would start knocking on the door.

I would answer.

The mashed potatoes and corn would join in.

I would answer.

Those times I managed to cover my ears and close my eyes to the temptation, the rolls oozing with melted butter would scream until they had my attention.

I would answer.

The pecan pie with the scoop of vanilla ice cream did me in every time.

From there I rolled downhill out of control, venturing to the all-you-can-eat buffets, the double meat double cheeseburger joints, the eggs and bacon breakfast with a side of pancakes topped off with a cinnamon roll, washed down with a couple of glasses of orange juice.

I would go through the drive thru at McDonalds and order a Big Mac, fish sandwich, and two large orders of fries, hoping rather than believing that the window server would think I would be splitting the bounty with someone at home.

I didn't split it.

I ate every morsel. Every fry. Every grain of salt.

And make sure I took my blood pressure medication.

And then feel so disgusted with myself and my lack of control that I would pull the cork on a bottle of wine and finish it in a couple of hours. I might even have a second bottle. It numbed me until morning, when work would loom ahead and put my self-loathing on the backburner.

Two things I clung to on my uncontrolled fall down the mountainside. First, I stayed true to my promise and did not drink alcohol during the day. That would have been a ticket to a rehab clinic or worse. Second, regardless of my mood, my aged cat Captain Hook would hop into my lap and I would pet him. Even then I knew he did me far more good than I did him.

He would listen to me drone on and on about nothing and everything not understanding a single word I said but feeling every wash of emotion from me.

The Captain kept loneliness from taking root in my soul.

I continued to gain weight, though. One pound at a time, one burger at a time, one bottle of Pinot Noir at a time.

I dreaded the weigh-ins with Dr. Hafford. I didn't want to see the look of disappointment in her eyes when she saw that not only could I not seem to lose a few pounds and keep them off, but I put them back on with a few more for good measure.

Twice I postponed my appointment a week to avoid the utter humiliation of facing her. More like facing the scales, really, since Dr. Hafford never judged me, always had a smile on her face, kept encouraging me to swap one meal a day for a protein shake, even when I didn't do that.

Dr. Hafford suggested that I see my primary care physician to keep him in the loop. Truly I didn't want to. While Dr. Hafford didn't judge my weight, Dr. Mason couldn't help but scratch the back of his head and lower his face to hide a grimace.

"I'm glad you're taking steps," he said, looking at the chart. "You were a pretty sick boy earlier this year with your gallbladder." He shook his head. "On day three and day four, it could have gone either way for you."

I did a classic double take. Then a triple take. "I'm sorry. You mean I could have died."

"You sure could have. Streptococcal sepsis is very serious."

"Excuse me. I had streptococcal sepsis?"

"You sure did. Nasty."

"My aunt died of that."

"A lot of people do."

I felt as though he poured ice water down my back. "Nobody told me. They said that I had bacteria in my blood that causes strep throat."

"That's one way to describe it, yes."

"Hang on. Nobody told me how bad it was. Not one second of those nine days did I not firmly believe I would walk out under my own power."

"And that's just the way they wanted it. The mind is very powerful, and your belief that you would go home served you well."

Holy sh*t!

I throttled my determination to take care of myself, but still couldn't lay off the massive amounts of food and, especially, wine.

And I hated myself for each bite I took, and each glass of wine I swallowed.

Oh, yeah. I needed help badly.

The last weigh-in, right after my cardiologist signed off on the surgery as "low risk," nearly brought tears. There I weighed in at 327.5 pounds (148.558 kilograms and 23.392 stones).

"I guess the insurance won't cover it since I've put on twelve pounds," I said, thoroughly humiliated and disgusted with myself.

She smiled. "From my experience, they would be less likely to cover you if you had lost forty pounds in the last six months. You gained some weight. Okay. But you tried and kept coming back to see me. That took guts, Mr. Hatley. We're going to do this."

We took my "before picture" at Dr. Hafford's office four days before the surgery.

As the day approached, my apprehension level increased logarithmically minute by minute. Did people really feel great after the surgery? Did people ever die during the surgery or from complications of the surgery?

Then again, everything looked good. Blood tests, EKG, the whole shebang. My checkup the afternoon before went very well. I showered that evening with the antiseptic soap they provided even though it smelled like a chemistry class.

But my heart beat fast and hard. Sleep wouldn't have come if it came, so I violated orders and had some wine to relax and shake the negative thoughts from my head. I forced myself to think thin, to will myself into a body I could live with even if I couldn't be proud of it.

The next morning, December 28, 2016, I showered with the chemistry class soap again, dressed in loose fitting clothes, then waited for my friend to pick me up and take me to the surgical center. On the way she asked questions I half heard. I gave answers to the questions I thought I heard, asked a couple of questions I almost heard answers to, and we were there.

I was there, but living in a world I'd never been to before.

The sun had not yet risen.

My friend wished me the very best. I took my overnight bag, and walked inside to check in.

I had no time to think about the gallbladder surgery or what today might bring. Was I ready? Did I have the courage? Would it work?

So many times in my life I had been a coward.

Not today.

—To be continued—

Rocky Hatley has been a Screen Actors Guild Member for over 25 years. He was born in Memphis, Tennessee more years ago than he would like to think about, and, as a child, was held by Elvis Presley. Raised in Texas, USA, he's a massive fan of music, plays guitar, and has the most amazing celebrity stories ever. Rocky is a passionate writer currently working on a novel loosely based on his experience as a SCUBA diving instructor. He is the co-writer of two plays produced at Manhattan South Theatre in Orlando, Florida. Barstruck and Bedtime Stories each enjoyed successful six-month runs. Rocky appeared in both. In his life he has, at times, been too thin and too heavy. This is an article about Rocky's journey to follow the lead of Goldilocks and find the "just right."

Worldwide, obesity has doubled since 1980. In 2014 the World Health Organisation (WHO) reported that 1.9 billion adults were overweight with 600 million of those being obese. Obesity kills more people per year than being underweight and it is preventable. Bariatric surgery - weight loss surgery - are surgical methods to help people achieve weight loss. This year, Texan writer Rocky Hatley underwent surgery to achieve weight loss. He's written a three part Up Close & Personal account of his journey for us. This is the first part. Read Part II here and Part III here. Thank you Rocky for sharing this unique personal insight into your experiences.

A little over a year ago, I woke just past midnight sweating, my breathing labored. Neither concerned me.

The chest pain did.

I stood, and amazed myself. "This can't be a heart attack," I thought. Wouldn't I be writhing on the floor like a fish on a boat deck? Wouldn't I be bent double, fist clutching my chest literally hanging on for dear life?

I'd gawked as my father suffered a heart attack in 1968. While his face twisted like barbed wire in a tornado, he grasped his chest as though trying to pull the agony out, failing miserably. From a sitting position in his favorite easy chair, he'd curl one way into the fetal position, then the other before sliding onto the floor, fighting to climb back on.

He survived. Barely, spending six weeks in the hospital and four months away from work and another six months working no more than half days.

I grabbed three aspirin from the medicine cabinet and dry-swallowed them, knowing from my scuba instructing days that they would thin my blood and lessen the severity of the heart attack.

If it was a heart attack.

It couldn't be a heart attack.

Could it?

My father had been 37 years old and in reasonably good shape

I turned 58 the previous September, morbidly obese with gallstones. Why-the-hell couldn't it be a heart attack?

I went to my own recliner to relax the pain away. That's all I needed to do right? Take it nice and easy for a while until the anxiety left in a huff. I focused first on my breathing. Long, slow, deep breaths. In through the nose. Out through the mouth. In and out.

I regained control of my lungs to some extent, but the sweat still poured down my forehead and cheeks and my chest still hurt. I went to my laptop and looked up the symptoms for heart attack.

Ah! Squeezing chest pain! Hey, not me. It hurts like hell, but no squeezing. No, sir. Not a bit. Pain shooting down the left arm? No sale. Not this kid. Just my chest hurt. Not my left arm. No squeezing.

And then ...

"If you experience severe chest pains, even with no other symptoms, seek immediate medical attention."

Whoa!

I poured a glass of wine and headed back to the easy chair, chest still hurting, looked at the phone sleeping on the side table and wondered whether to call 911?

Or wait it out?

I decided to wait half-an-hour. If the chest pains didn't ease, I would call. If they worsened during that half-an-hour, I would call.

Otherwise, I could keep my paranoia in check. I finished the first glass of wine and poured another.

In the meantime, I thought about my father and how frightened he had been even while ordering my ten-year old self not to call for an ambulance.

After half-an-hour of no improvement, I gave into the inevitable and called 911, my face burning with humiliation.

How could I let this happen to me? How could I have eaten so much and drank so much that it turned me into a human haystack.

"What is the nature of your emergency?"

"I'm having check pains."

After confirming my address, the kind, sympathetic woman assured me that help was on the way, and that I should unlock and open my door. I unlocked it, but I had no intentions of opening it until they arrived. My cat Captain Hook might get out and, at his age, would be mauled before the ambulance made it half way.

I would not take that risk.

The blaring siren at a little past one o'clock in the morning signaled the arrival of the ambulance. The rapid, loud footfall on the stairs signaled help.

The paramedics had arrived.

I had anticipated two, with a driver waiting down in the ambulance. I got super service. Six burly firefighters (who doubled as paramedics) ready for anything entered my humble abode.

Captain Hook hightailed it to the back of the apartment with the usual hitch in his gitalong, most likely winding up under the bed.

While I tried to relax, two of the burly men hooked me up to a gaggle of wires while a third checked my pulse asking me how I felt, how severe the pain had become, all the predictable questions, to which I gave appropriate replies.

After about ten minutes of prodding, poking, and bad joking, the head guy, standing a good six feet four inches, said, "Mr. Hatley, I can't stand here and tell you that you aren't having a heart attack. It's your call, but I would suggest having it checked out in the hospital ... tonight."

I opened my mouth to say something brilliant and life changing, but shut it tight and nodded, fighting hard to hold back fear tears.

Lord, was I scared.

At my rather rotund 327.5 pounds (148.558 kilograms and 23.392 stones) at every inch of five feet seven and a half inches tall, it took all six of the burly men to carry me to the gurney just outside my door, put me on, strap me in and negotiate it down the stairs featuring a hairpin turn.

Once in the ambulance one of the men handed me a tiny pill and said, "Put that under your tongue."

I recognized the pill, though it had been decades. "Nitroglycerin?"

He nodded. "Just put it under your tongue."

I smiled. "My father used to carry these around in a case that looked like a fountain pen."

"You have a family history of heart disease?"

My mind half traveled back to him writhing in his easy chair. "He had a massive heart attack when he was 37."

"Is he still living?"

I shook my head.

"His heart?"

I shook my head. "Brain tumor."

"How about your mother? Still living?"

I shook my head. "Cancer."

"Siblings?"

"Two. One living."

"What happened to the one who isn't?"

"My sister. Complications from diabetes."

"Type two?"

A tear broke free from the corner of my eye and rolled down toward my ear. "Type one."

Every word out of my mouth seemed to seal my fate. Except that by the time we reached the hospital the chest pain had vanished like a morning fog.

"Guys," I said. "The pain's gone."

"Completely?"

"Almost."

The ambulance came to a screeching halt.

"All right. Let's get you in."

I didn't understand. The pain had departed. I needed to go to work later on with not much time left for sleep.

Before I could even ask if they would take me home because it had clearly been a false alarm, they had me isolated behind curtains replacing one gaggle of wires with another, paying no attention to me.

I heard a rapid blip, blip, blip from behind and understood that they now had the heart monitor set up. The nurse then kindly muted the volume so I wouldn't be drawn to the beating of my own heart. One hitch in the rhythmic blips, and I might panic.

By three o'clock in the morning, I texted my boss, laying it on thick, mentioning that I had landed in the ER with chest pains and that they would be running some tests and that I wouldn't be into work.

I felt a bit guilty for having embellished the situation until I asked for some water.

She offered me a wan smile. "Not tonight. We're in the process of getting you a room."

"The chest pains went away," I said, with more desperation than I intended.

"Right after you took nitroglycerin, sweetie. And you have a family history of heart disease and Type 1 diabetes. That's why we're admitting you."

Sweetie. I felt like a customer in a cheap diner.

"Just lay back and try to get some sleep while we sort you out."

Sort me out. Now, I felt like a Jack in a deck of cards.

For the next fourteen hours, I became a laboratory specimen. Drained of blood and urine, sonogramed, stress test injected, and CaT scanned with attached panels that showed me the true depths of claustrophobia.

My room served as a weigh station.

All the while I wondered why the world had done this to me. The ginormous meals, the massive quantities of wine. I scrunched my eyes closed in shame thinking about how many days off I wasted by pulling the cork on a bottle of wine at six in the morning, and staring absently at the television not remembering what I had watched ten minutes after it ended.

Wasn't I a decent person?

At about five o'clock the next afternoon, the cardiologist came in. I don't know why I expected someone older, or why I did a double take at this man's youth.

"Mr. Hatley," he said walking up to the bed. "Your heart is fine. Excellent, especially considering your weight. You did not have a heart attack."

I sighed with palpable relief, and horrible embarrassment.

"I'm so sorry. I should have just sucked it up a little while longer at home."

He stepped closer to the bed and put his hand on my arm. "I would like to introduce you to a couple of people who sat in the same chair you did once upon a time. Chest hurting. Sweating. Frightened. Facing the same decision you had. Only they didn't call. I'd like to introduce you to them, but I can't because they're dead. You did exactly what you should have done, and if it happens to you again, you do exactly the same thing."

I wiped a tear away.

He told me to see my primary care physician within a week and to schedule an appointment with him within two.

I did so.

Both physicians suspected that my gallbladder had been the culprit. A gallbladder attack, they said, can mimic a heart attack. A sonogram confirmed it, the official report saying that it had become "sludge."

Even before I could follow-up with the cardiologist, a surgeon called to schedule an appointment to discuss removing my gallbladder. I didn't realize that in the beginning, because the first word of her subtitle on the Internet read "Bariatric." I knew that word well. It was surgery for fat people not strong enough to pull their britches up and lose the weight.

Bariatric.

I swallowed, finally understanding that I had done this to myself.

Me.

Alone.

My view of the world had merely been the catalyst.

I recalled having been weighed in the hospital, and how the technicians made rueful faces as the arrow finally balanced well past the three hundred pound mark.

I longed to say to those disappointed faces, "I'm so sorry I did this to myself, and that you have to pick up the pieces." But they weren't the folks I needed to apologize to. To find that person, I needed to look into the mirror.

—To be continued—

Rocky Hatley has been a Screen Actors Guild Member for over 25 years. He was born in Memphis, Tennessee more years ago than he would like to think about, and, as a child, was held by Elvis Presley. Raised in Texas, USA, he's a massive fan of music, plays guitar, and has the most amazing celebrity stories ever. Rocky is a passionate writer currently working on a novel loosely based on his experience as a SCUBA diving instructor. He is the co-writer of two plays produced at Manhattan South Theatre in Orlando, Florida. Barstruck and Bedtime Stories each enjoyed successful six-month runs. Rocky appeared in both. In his life he has, at times, been too thin and too heavy. This is an article about Rocky's journey to follow the lead of Goldilocks and find the "just right."

It is not uncommon for people to come into the clinic seeking strategies to manage their fears about having an MRI or other scans such as bone scans or CT scans, particularly if they are a part of the monitoring and management of a chronic health condition.

Unfortunately, like any of our fears, if we have an uncomfortable or distressing experience the first time we try something, or we simply don't understand a situation, our anxious brain tends to blow it out of proportion making it ten times scarier than it actually is or was. In fact, we call this catastrophising - a common unhelpful thinking style - where we take a tiny lion cub and turn it into a life threatening roaring king of the jungle in our minds. Fear, anxiety and our fight/flight systems kick in accordingly. You can read more about that in our previous articles on anxiety here.

The purpose of this Coping Toolkit entry is to describe three brief and effective strategies for managing that claustrophobic feeling of being in an enclosed space such as in an MRI machine.

As you'll have read in my recent article Anxiety & the MRI, I recently had the opportunity to practice what I preach when I had to manage my own anxiety whilst in the MRI tunnel for one and a half hours!

For the uninitiated, MRI stands for magnetic resonance imaging and the machine looks like our feature photo at the top of this article.

Depending on what you are having scanned and whether you go in head first or feet first, there's a chance you can end up deep in that narrow tunnel for fairly lengthy periods of time. Lucky (not lucky!) me went in head first for a full spinal scan which meant that the further in my body went to the tunnel, the more my mind played tricks on me and the more anxious I felt. I will be writing about claustrophobia in the Analyse This section shortly - fascinating stuff!

If I'm honest, the anxiety began well before scan day and gradually built to peak levels the night before the appointment which was when I had to have a serious talk to myself which went along the lines of "For goodness sake, you're a psychologist, you know how to manage this stuff!" And so I did (because I had to).

At The Appointment:

Owen, my MRI guy, said that it was normal for people to become anxious when having an MRI and that most people swear by using an eye mask - if you can't see you're in a confined space, it's easier to relax. Not me.

I'd already made the mistake of looking into the tunnel first. I knew too much.

Plus, one article I read about claustrophobia said that the anxiety comes from the enclosed space blocking out important sensory information, so I figured that also blocking my vision couldn't possibly help.

Instead, I chose the angled mirror which helps you look out of the tunnel despite the fact that you are lying on your back and actually looking up at the top of the tunnel. In the last MRI I'd had (for 'fun' mind you, as a part of a research project) I used the mirrors and they'd helped me feel less confined, so I already had some confidence this would work again.

Owen also encouraged me to bring a CD into the appointment to listen to as the machine is very loud, so armed with my Learn Italian disc, I was fitted with headphones and given a buzzer to hold in my hand in case I needed Owen at any stage. All of this was very reassuring and comforting.

After positioning me on the machine, Owen left the room and my anxiety began to rise.

The Feeling:

I can feel it again now recalling the memory of nine days ago. My chest became tight, my heart rate increased and the butterflies took flight in my stomach. Part of me worried that I would make a fool of myself in front of Owen.

Luckily, another thought process kicked in though and reminded me that this would be a good opportunity to try out some of the coping strategies I taught my clients. No pressure! I chose to use a controlled breathing technique.

I held my breath and counted to six. I wanted to take control back over my breathing which had automatically responded to the misconstrued 'threat' of entering the tunnel - good to see my fight or flight response was alive and well.

Then, I exhaled to the count of three.

Next, I inhaled, again to the count of three.

Slow, deep, purposeful breaths, controlled consciously by me.

One exhalation and one inhalation equalled one cycle.

I did nine of them, all the while, counting the length of my breaths as well as the cycles. This served to fill up my working memory. I was holding and manipulating information at the same time, occupying the limited capacity of my working memory so that other kinds of thoughts - the unhelpful ones! - couldn't creep in.

I'm happy to say, that by the end of cycle seven, my anxious symptoms had disappeared and I refocussed my attention onto thoughts about how successful that had been, and then onto my Italian lesson. Molto bene!

The Thinking:

I've previously described the ABC Model which explains the close link between our thoughts and our feelings in other articles, but just a quick recap:

We generally have a situation - the A (an activating event) - followed by our thought/perception - the B (belief) - which then tends to influence our feelings - the C (consequence).

In this case, the A is having the MRI, the B's are what we tell ourselves about that scan, and the C's are our resultant feelings.

Some of my less-than-helpful thoughts included these:

"I won't be able to get out if I need to.""I'll be trapped inside the tunnel.""I won't be able to breathe."

And of course, I had my whole repertoire of worries about the scan revealing my breast cancer had returned to keep trying to trick me into feeling scared.

About thirty minutes into the scan, my anxiety re-appeared.

This time, I chose a thinking strategy from a cluster of tools called defusion strategies - they come from Acceptance and Commitment Therapy (ACT) and are aimed at changing, not the thought content, but instead, our relationship with the thought.

There are many ways of doing this and I will go into these in more detail in a future article, however, the strategy I used in the machine relied on humour.

I took the thought, "I don't think I can stand this for a minute longer" which when it stands alone, is a fairly serious and scary thought, considering where I was and the fact I still had an hour left to complete the scan.

I knew I had to quickly let go of that worry - to 'de-fuse' from it - in order for it to stop impacting on my anxiety levels, so I chose to turn it into a funny thought - something I could laugh at instead.

I brought up an image of Sheldon Cooper from the television show The Big Bang Theory (image courtesy of atmedia.imgix.net). I pictured him sitting in his position on his red leather couch, wearing a short sleeved t-shirt over a long sleeved shirt and then I saw him look right through the camera at me, as he repeated my thought to me, word for word.

Before he'd even finished the sentence with his slow American Southern drawl, I'd already begun to smile at how funny it sounded and I was able to re-focus my attention onto other things.

I'd bought myself some emotional distance from the thought as it was now Sheldon's thought and not mine. The fact that I find him so funny also allowed me to easily detach from it and let it go.

Immediately my anxiety levels dropped.

The Moment:

Around thirty minutes later, now up to my lower lumbar spine, I was as far into the tunnel as I was going to get and upon that realisation, my anxiety began to peak again.

While the mirror had afforded me the luxury of watching every move Owen made in his office thanks to the large window between his room and mine, it began to have the opposite effect when his colleague joined him.

No sooner had she arrived when they both began to look incredibly concerned, frowns on their faces, pointing to the computer monitor!

Of course my mind went into over-drive - they'd clearly discovered something horrific in my spine! Unhelpful thoughts popped into my head faster than a speeding bullet feeding my anxiety. I knew I had to quickly regain control over my mind and where it was focussing its attention if I was going to remain in the machine as long as I needed to.

This time, I chose to re-focus my attention back into the present moment with a mindful grounding technique.

The most simplest form I can think of to practice mindful grounding is to take the position of the curious, open-minded scientist, and observe your immediate environment, asking yourself the following five questions:

What are five things I can see?What are five things I can hear?What are five things I can feel?What are five things I can smell?What are five things I can taste?

I chose to use my sense of sight and realised quickly that if I looked up and backwards from the mirror, there was a perfect gold sticker right above my head.

I began describing that to myself in great detail.

Mentally, I traced the outline of the sticker, noticing its rectangular shape and slightly rounded corners. I noticed how it sat flush with the machine, no parts of it had lifted and it contained no air bubbles. The bloom from the lighting in the back of the machine - it is very bright in there - caused the metallic gold to reflect and refract the light in lots of different ways.

While I marvelled at all of that, my anxiety once again calmed down. My mind was full of thoughts about an object that I chose to focus on and every time an unhelpful thought tried to trick me into feeling scared again, I noticed it (easy to do when you start to feel distressed!) and refocussed my attention back onto that sticker.

Once I finished with the sticker, I noticed a solid grey band that ran behind it and circled the entire tunnel, providing me with a new focus for my attention.

Summary:

Remember that I have been teaching and using these strategies regularly for years and so for me, they have become automatic processes.

In order to make them automatic for you too, I suggest you rehearse them when you are feeling calm initially. Try them on neutral or positive thoughts to get the hang of imagining your character or focussing your attention on an object.

Once they become easier and more automatic for you, perhaps then you can rehearse them during slightly more uncomfortable situations, gradually building your confidence in both using the strategies but also in their effectiveness.

Congratulations, you've just added three new tools to your Coping Toolkit!

Sometimes we have bad days and sometimes those days turn into weeks. We don't always know why, often because it's what's happening subconsciously that's causing the problems. In those cases, it can help to work backwards to try to figure out what's wrong. I just had one of those weeks and this is what I figured out.

Last Friday, I had an MRI (magnetic resonance imaging) scan on my spine - nothing serious, just some postural stuff going on due to all the sitting on couches that I do, I'd say (the psychologists' occupational hazard). It'd been booked for around three weeks and I hadn't consciously thought of it in the lead-up other than it being an appointment I had to attend.

Monday started well, work was busy, clients were doing well, I'd squeezed in some exercise and had been watching Married at First Sight (I love that show - what a behavioural experiment!). Life was pretty good.Tuesday, nothing out of the ordinary occurred although I noticed I felt more tired than usual but by Wednesday I noticed a total shift in my mood. I felt flat and not very enthusiastic about getting out of bed in the morning. My schedule of clients and programs to run weighed heavily on my mind (not a usual occurrence for me) and I had to drag myself through the day.

By Thursday, I felt on the verge of tears all day, which if you've read my previous article on crying, you'd realise was a sure sign there was something up. A couple of caring colleagues checked in with me that day, "Are you okay?" which caused me to reflect. Am I?"Yeah, I'm okay, just a bit tired I think," came my standard response. By the afternoon when I felt as though I didn't want to see my final three clients and actually considered cancelling them despite one already being in the waiting room (something I have never even considered before!), I realised something was wrong.

Thankfully, I managed to see my clients and give them quality sessions. I even managed to pick up my nephews from school, get them to sport, make my Pilates class and attend another appointment I had, all the while having the niggling question in the back of my mind, "what is going on with me this week?"

When I couldn't come up with a single definitive explanation for why I felt so unsettled/anxious/burnout/stressed I decided to work backwards.

I've previously described the ABC Model of cognitive therapies:

Where an Activating event is followed by a Belief that influences the Consequence - our feelings.

Sometimes, we are lucky enough that we are conscious of our thought processes and can easily put the A-B-C together in order in a serial fashion, but more often than not, our thinking occurs automatically on an unconscious or even subconscious level that either requires us to direct our attention to the problem-at-hand to solve, or requires us to appraise the situation in order to conclude the most likely explanation by working in reverse.

What that looks like in practice, is that we begin by noticing the 'C', the feeling. The change in mood was definitely the first thing I'd noticed over the week and it hadn't been pleasant.

To work backwards, you then retrace your steps in a way - going back to the 'A' the activating event - by asking yourself, "Okay, what's been happening in the last few days that I've been feeling this way?"

The fact that my mood had worsened the closer I got to Friday held the key for me and as I spoke to a beautiful friend on the phone Thursday night, I started processing my thoughts - the 'B' - on a conscious level, revealing the likely worries to myself at the same time as verbalising them to her.

I had surmised that I had subconsciously been worried that the MRI scan would show that somehow I'd had a cancer relapse. Not only that, I felt angry at and disappointed in myself for feeling anxious about cancer because "after seven years, I SHOULDN'T be worrying about it anymore - it was behind me". Not only that, but I also told myself that "I SHOULDN'T be anxious about having an MRI because I've had way worse things happen to me than that, so I SHOULD stop being ridiculous."

These are some good examples of unhelpful thoughts - any thought that is unproductive and is linked to uncomfortable emotions.

I'd obviously had all of that going on in my mind somewhere - any wonder I felt like crap!!

I'd been giving myself a really hard time and I didn't even know it. My fear about the MRI related directly to my fear of getting sick again, which all relates back to my fear of death. Thank you survival instinct. Thank you amygdala. My unconscious primal brain was just doing its job!

Once I'd identified and spoken about my fears, I felt immediate relief and was able to mentally prepare myself for the MRI the next day. It wasn't fun or easy but I chose to use it as an opportunity to practice what I preach and I'm happy to say that I successfully engaged in three psychological tools that helped me cope while lying in a small noisy tunnel for one and a half hours.

MRI's commonly bring clients into the clinic for assistance because they commonly cause anxiety in the form of claustrophobia. I'll be heading over to the Coping Toolkit now to write some tips on how to manage your anxiety if you have to have an MRI of your own. I'll also be writing about some common unhelpful thinking styles and what to do about them, not to mention an Analyse This article on claustrophobia. That should keep me busy for a while!

Do you have a topic you'd like to read about or a question you'd like to ask? Please send us a comment or a message and don't forget to share us with your friends and subscribe to our newsletter halfway down our home page. Big love, Jodie x

I'm a late bloomer when it comes to being a grown-up. While my friends' handbag collections were growing by the week, I persevered with (stylish) backpacks well into my thirties and when they woke-up an hour early to apply make-up and straighten hair, I prioritised extra sleep!

Genetically blessed, our mother had luminescent, line-free skin right up into her late sixties. She used only soap and water to cleanse her face and wore makeup only if she was going out at night. To work she wore a dash of lipstick and a stroke of mascara and that was it. She didn't need any more.

No surprise then that neither my sister nor I adopted the habit of wearing makeup every day - it just wasn't modelled for us, so as much as anything, I guess we never learnt how to. When I think back to childhood now, sitting and watching mum apply her makeup before going out on weekends became a mesmerising event. Even now I can smell the perfumed foundation, feel the sensation of the makeup brush across my cheek that I'd beg her to do, and see the bright colours of the lipstick she'd apply, sometimes sharing it with us as a special treat. The fact that she only did this on special occasions made it all the more special for us as well.

There have been times in my life where I've questioned my femininity because of my natural appearance. I've spent a lot of money on cosmetics with good intentions of being like 'normal' women and making up my face every day, but the habit never stuck, that is until recently.

If you've followed my recent posts, you'll know that I visited India late last year. The weather is so hot there that I felt constantly saturated with sweat, which wasn't quite as gross as it sounds however, enough for me to be glad to not have to apply makeup on a daily basis!

Our tour group consisted of mostly women and there were two in particular who fascinated me by wearing makeup every single day irrespective of the weather. Not once did they appear as though their faces were melting off and they both looked so composed and together 24/7, I was spellbound. This level of perfection occurred whilst touring around a country where makeup is a way of practising one's religion and culture. It couldn't go unnoticed.

I found myself at the airport in Bangkok on the way home perusing the multitudes of products in the MAC store and before I knew it I left armed with a number of products to apply to my face to look more 'natural'. Oddly, I've worn makeup every day since returning. That in itself is fascinating to me. Why now? It's true, I'm getting older. There are more smile lines than ever before that no longer disappear when my face relaxes, but we all know makeup only enhances those... so I decided to do some reading on the topic. This is what I found:

You'd be surprised how many articles you can find on the 'psychology of makeup'.

There are those articles that talk about the evolutionary aspects of makeup, where our physical characteristics are linked back to reproduction. For women, that means having fuller, redder lips, even skin tone, large eyes and blushing cheeks.

Other articles linked makeup to mental health, mainly through self-esteem and body image, highlighting two opposing functions of makeup - camouflage and seduction. One article suggested that women who associated makeup with camouflage were more likely to be anxious, defensive and less stable emotionally. Where seduction was the objective, women were more sociable, assertive and extroverted.

In one paper, findings suggested that while both men and women perceive women who wear makeup as being of a higher status, men associated it with more prestige while women perceived it more negatively as a sign of dominance and potential threat.

While interesting, none of the research I read seemed to explain my own personal shift to wearing makeup, so I continued my search.

I shouldn't have been surprised to find a link to facial perception, I mean, a single glance at someone's face can tell us information about their identity, their mood, even where they're directing their attention and there are multiple regions in our brain dedicated to reading other people's faces.

Finally, I found some information that made sense to me on the Medical Xpress website. Professor Richard Russell stated that makeup is more related to the 'health' of the face, with healthier looking faces exhibiting more contrast between facial features, evenness in skin colouration, rosier cheeks and more expression - all of which can be enhanced with makeup.

It made even more sense to me when I flashbacked to attending a Look Good, Feel Better workshop whilst in the midst of cancer treatment. The workshops are aimed at giving women some control over looking good when they aren't feeling it. In my experience, missing hair, eyebrows and eyelashes, with a constantly bloated and pale face, looking like a cancer patient made me feel even worse than just the physical effects of the disease. The makeup lesson helped to replace missing brows and give contours and colour to an otherwise puffy face. It changed everything. It made me feel not only more confident with a good boost to my self-esteem, it made me feel as though I looked healthier.

Healthiness is predicated on happiness. We perceive happy people to also be healthier and that's the feedback I've been receiving that's positively reinforced my daily application of a bit of powder, eye-shadow, mascara, blush and lippy.

"You look so well!" they say, and the good news is, I feel it too.

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